My friend Barb opened a window into the extraordinary loss she has endured because of ME/CFS. Please read her powerful statement, and count her among the #MillionsMissing.
If you want a tiny peek into what I live with every day, read what I have written here. I rarely post such an in-depth look publicly, because of the stigma around chronic illness and disability. It hurts when people judge me for how sick I am. And many do. It hurts when people leave me because of chronic illness. Which some do. It hurts when people blame me for being sick. Which some do. So I avoid talking “too much” about the specifics of how bad it is. For some people, talking about it at all is “too much.” But today is the day of the #MillionsMissing protest against the government’s inaction regarding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and I can’t go to any of the in-person events because I’m housebound disabled by the illness. I can only protest virtually. So this is my virtual protest: an attempt to educate anyone who cares to learn about the effects of this disease that has stolen my life, and the lives of millions of others like me.
Millions of us are missing from the lives we thought we were going to lead.
I am missing from the work force. I WANT to work. I can’t work any job. I can’t meet deadlines. A few weeks ago, someone offered to pay me to help her do some research for a book she’s writing. I have yet to be able to do a single thing to help. I wanted to try, I’m still trying to try, but my cognitive and other physical functioning is fleeting and unpredictable. I have yet to experience a moment of cognitive function sufficient to allow me to read an article and remember anything I read beyond the first few sentences. I constantly have to start reading over, and retain nothing.
I am missing from any definition of financial security or stability. My meager disability income is insufficient to cover even costs of living. I’m missing from the Medicaid and Food Stamp rolls, because my meager disability income is still higher than the draconically low income cap those programs require. Since I don’t qualify for Medicaid, I don’t qualify for in-home help around the house or errand-running assistance. So I’m 44 years old and dependent on my family for food, shelter and errand-running. It’s quite the indignity for all of us. I am a burden on my family. They love me, but that doesn’t mean they are not burdened by sharing my expenses. My parents should be retired, but they’re working partly in order to support me. My brother also works to support me. That weighs very heavily on me.
I am missing from the grocery store. Even if I could fit food costs into my meager disability income budget (I can’t), I don’t have the strength to go shopping
I am missing from my avocation, sea turtle conservation.
I am missing from field research.
I am missing from laboratory research.
I am missing from wildlife rehabilitation.
I am missing from Herpetology.
I am missing from Marine Biology.
I am missing from Ecology.
I am missing from Environmental Science.
I am missing from Science.
I am missing from Academia. I haven’t even been able to publish my doctoral research because my brain doesn’t work well enough anymore. The article is written, and only needs the final step of finding more recent citations on the subject, but I haven’t even been capable of doing that simple thing for the past eight years that I’ve been disabled.
I AM MISSING FROM MY OWN BRAIN. The loss of my cognitive function, my sharp wit, my brilliance is the most tragic loss I have suffered from this illness. People used to call me a genius. Now I’m average or above average. That might not sound like a big deal to someone who has not suffered the loss of their intellect, but it is a big deal to those of us who have. I can’t read books, I can’t read scientific articles, I can rarely even get through an article in Time magazine if it’s more than half a page. That’s highschool-level reading. My brain is slow, full of fog and mud. Thinking, focusing, concentrating, analyzing, assimilating information, remembering…these are all struggles that wear me out after a short time. So much of the education I busted my ass for has faded away. I expect to get my usual Post-Exertional Relapse from writing this.
I am missing from the stage. I can’t sing any more. Every time I try, I get Post-Exertional Relapse. The technical term is Post-Exertional Malaise, but that term doesn’t adequately describe the debilitating exhaustion and pain that any exercise causes. Singing was one of the greatest pleasures I had in life.
I am missing from the creative world. I used to write poetry, paint, draw, make all kinds of jewelry, make lovely things with polymer clay. I used to have a soaring imagination. Now my head is full of fog, and trying to create anything is like pulling teeth. I have been working on the same necklace for 3 (or is it 4?) months now, and I’m not sure I’m even half done. I am missing from most of my former hobbies, including marine aquariculture and most of herpetoculture. I wouldn’t have any pets if I weren’t willing to spend some of my precious, limited energy on my few small reptile pets. Life without pets is unbearable to me. So I compromise. I borrow energy from the future so I can have a little quality of life with animals now.
I am missing from my friend’s lives. I am missing from social interactions. Weddings, baby showers, barbecues, birthdays, funerals…I can’t travel, so I’m missing all of these things. I couldn’t even go to the funeral of a dear friend. I couldn’t support her husband, either, and he’s a dear friend. The isolation this disease causes is profound and devastating.
I am missing from my own support group. I’m a co-leader of a support group for people like me, yet I’ve only been to one or two of the monthly in-person meetings this year, and have rarely been capable of answering the emails and phone calls that are part of my responsibilities. I WANT to do those things. I WANT to be capable of doing them. I find them fulfilling and uplifting. But they require more physical and cognitive function than I’ve had for a while now.
I am missing from restaurants, movie theaters, plays, and all the other fun extracurricular things I used to take for granted that I can’t do anymore without getting Post-Exertional Relapse.
I am missing from the beach. Sometimes I wonder if a person can literally die from pining for the sea. I wish I were joking. Every year, I see my friend’s photos of their beach vacations, and I feel torn up. I feel whole when I’m at the ocean. It’s my happy place. But I can’t travel, nor do I have the strength to walk down the sand to get to the ocean. So I’m a marine conservationist who hasn’t seen the sea for 10 years.
I am missing from walks in the woods.
I am missing from hikes in the mountains.
I am missing from camping in the wilderness.
I am a naturalist and nature-lover missing from Mother Nature.
I am missing from motherhood. It didn’t happen for me. Now that I’m past reproductive age, it will never happen for me.
I am missing from a loving partnership/relationship. No one wants to date someone as chronically ill as I am. I’ve had nibbles of interest, but they always disappear as soon as they learn how disabled I am. This is what the majority of us experience. Most of us fear that no one will ever love us enough to be able to see past our illness.
I’m missing from a tidy home. I moved into my new place in November of last year, and have only been able to unpack about a dozen boxes. Unpacking is such an epic overexertion that I get Post-Exertional Relapse for days afterwards. Cleaning my own home is a pipe dream.
I am missing from a refreshing night’s sleep. I don’t think I’ve had one this century.
I am missing from pain-free days. I’ve only had one since I came down with the Mononucleosis that developed into ME/CFS in 1996. That one pain-free day happened after I received acupuncture, which I can’t afford now.
I am missing from clinical trials. I have been too sick to travel to the very few that have happened, and can’t afford to pay to participate in the long-distance ones.
I am missing from formal medical education for doctors. There are a handful of doctors in the US who are interested in ME/CFS, and they go out of their way to learn all they can about the disease. But there is little for them to learn, because there is little research or research funding.
I am missing from the only treatment that has made any difference in my symptoms, because Medicare (or most insurance) does not cover Traditional Chinese Medicine, and I can’t afford to pay for it myself. In the 9 years I’ve been disabled, conventional medicine has had nothing to offer me, but herbal medicine made a big difference in my functioning and quality of life when my family and I were able to afford it. That time has come to an end, and so has my hope for recovery as long as the government continues to do nothing. Without government funding for research, large research studies aren’t going to happen and western medicine won’t have anything new to offer us.
I am not alone in any of this.
There are millions of us.
Millions just like me. Some are sicker than me and some are more functional, but all of us struggle to survive with this illness.
Millions dismissed and ignored by the government, medical and research systems.
We are not lazy. We are not crazy. We are not lacking moral fortitude or motivation. We are suffering terribly from an as-yet poorly understood neuroimmune disease. It acts like a neuroimmune disease, anyway. We’d have a better idea of what kind of disease it is if we could get more research going. There was a time when diabetics, people with MS and other invisible diseases that are now legitimized were also dismissed as psychosomatic. What led to legitimacy? Research. What leads to treatments? Research. What leads to research? Government funding.
We need help.
We are sick and tired of surviving, waiting for the government to get its act together and fund research into this disease. We want to LIVE, not just survive. We want to go back to work, or school, or hobbies, or out to eat, or out to a movie, or just have a day in which we don’t have to consider the sickening consequences of every single, tiny thing we do. We would love to have a day in which we could dress ourselves or fix a snack without worrying if we’ll have the energy to eat later. We would love to be able to take having the energy to get out of bed for granted.
Surviving in limbo is hard work.
We just want to LIVE.
PACE-Gate
PACE-Gate was launched by academic/journalist David Tuller, DrPH (Lecturer at the School of Public Health and Graduate School of Journalism at University of California, Berkeley) with his 2015 article series, Trial By Error, which dismantled the bad science in PACE. Tuller was assisted by the work of many “citizen scientists,” ME/CFS patients who worked for years to carefully analyze the study and as much data as they could obtain.
For five years, ME/CFS patients have known and insisted that the results of the study – even if it had been perfectly designed and conducted – are not applicable to us because the subjects were fatigued, and were not all suffering from ME/CFS. But as Dr. Tuller covered in such detail, the study was the opposite of perfectly designed and conducted. Subjects could worsen during the course of the trial and still be counted as recovered at the end because of post hoc changes in study design – and that is just one of dozens of fundamental flaws in the PACE trial. Yet still, the study is hailed as the largest clinical trial in our disease and as proof that we only need to exercise and shed the “belief” that we are sick in order to recover. Reminiscent of launching a thousand ships, Dr. Tuller’s articles kicked the bad science scandal into high gear, and efforts to expose the truth about PACE began to multiply.
Attempts to secure data from the PACE trial – anonymized to protect patients, of course – are of interest to scientists inside and outside the world of ME/CFS. As they have done for years, the PACE authors continue to block these efforts. In November 2015, Dr. James Coyne (Professor of Health Psychology at University Medical Center, Groningen, the Netherlands) filed a request for the data from the PLoS ONE article on the cost-effectiveness of the treatments evaluated in the PACE trial. King’s College London refused the request, claiming it was “vexatious.” This set off a flurry of protests from scientists, including those at Retraction Watch who called the reasons for rejection “absurd.” Dr. Coyne made PLoS aware of his request, since its policies require authors to make data available for papers published in PLoS journals. As of May 9, 2016, Dr. Coyne has still not received the data, and it is unclear if PLoS will actually enforce its data sharing policy. Dr. Coyne told me, “I am leaving things in PLoS’s hands. I am considering a range of responses if the Journal does not produce the data or retract the paper.”
Graphic credit: Radhika Bhatt, U.S. Department of Commerce Data Service
In December 2015, Dr. Tuller was joined by Dr. Vincent Racaniello (Professor of Microbiology and Immunology, Columbia University), Dr. Ron Davis (Professor of Biochemistry & Genetics, Stanford University) and Dr. Bruce Levin (Professor of Biostatistics, Columbia University) in filing a request for “the raw data for all four arms of the trial” on the original primary outcomes and measures of recovery. This request was denied by Queen Mary University of London in January 2016. Dr. Tuller told me that they appealed this decision, but QMUL declined to undertake a review. Tuller and the other scientists filed an appeal with the Information Commissioner’s Office, but they expect it to take many months for the ICO to come to a decision.
Valerie Eliot Smith has been tracking the slow progress in the case of another PACE data request to QMUL. Alem Matthees filed a request for PACE data, QMUL refused, and he appealed to the ICO. The Information Commissioner ruled in his favor, but QMUL appealed that decision to the First-Tier Tribunal (Information Rights). That hearing was held at the end of April and a decision is expected very soon.
In the absence of direct access to the data, multiple requests for independent review of the PACE data have been made. In November 2015, Dr. Vincent Racaniello and five colleagues published an open letter to Dr. Richard Horton, Editor of The Lancet, urging the publication to “seek an independent re-analysis of the individual-level PACE trial data.” After three months without a response from Dr. Horton, Dr. Racaniello published the open letter again, this time joined by an additional thirty-six scientists. Dr. Racaniello told me that Dr. Horton “invited us to submit it as an ‘official’ letter to Lancet, which would be published; and we did that. No response from him or Lancet yet.” Dr. Horton did not respond to my request for comment on when this letter will be published.
Advocates have not been silent, either. More than 2,200 people joined in the requests of CDC and AHRQ. More than 12,000 people signed an MEAction petition demanding retraction of claims made in PACE papers in The Lancet and Psychological Medicine, and further asking that independent researchers be given full access to the anonymized raw data from the trial.
I asked Dr. Tuller where he thinks the PACE controversy is headed. He said, “I have to believe that the scientific community will gradually demand that it get retracted or the pressure to release the data will be so overwhelming that QMUL will finally decide that its institutional interests diverge from those of the authors. Perhaps the tribunal will make a strong argument in favor of data release–or perhaps the opposite. I don’t know.”
What can we do? Dr. Racaniello said, “Share David Tuller’s articles on what is wrong with the study. If these are too complex, use his bullet point summaries. The patient community has been active but we need more scientists and physicians to weigh in on the problem.”
I think the opinions of scientists are the key to a solution here. Dr. Racaniello told me, “I think it’s bad science that was poorly reviewed. Why Lancet is not willing to re-investigate is a mystery.” The Lancet has faced this problem before. PLoS appears to be back pedaling from enforcing its own data sharing policies. The PACE authors and their universities are refusing every data request at every turn. And unlike the previous five years, the Lancet, PLoS, PACE authors, and universities are not doing this to allegedly vexatious patients who are allegedly part of an allegedly vast conspiracy to make their lives difficult. The Lancet, PLoS, PACE authors and universities are doing it to scientists not previously associated with ME/CFS.
My experience as an ME/CFS advocate has taught me that this disease is the perfect case study for many issues in research, policy and medical care. The PACE trial is one such example. All scientists who care about strong peer review, open data, and verification of results should care about PACE, even if they don’t give a hoot about ME/CFS. Anyone who cares about translating good science into policy, medical education and healthcare should care about PACE, even if they are not interested in ME/CFS.
But as I said last year, and I say again this year: We will not see the change that we need and the resource investment that we need until we find a way to leverage the awareness into action. As advocates, we should do everything we can to communicate about the PACE issues to scientists outside the ME/CFS community. They can help boost the signal enough to get the Lancet, PLoS, PACE authors and universities to pay attention and take the necessary actions to bring PACE-Gate to the correct conclusion.